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How Medicare And Medicaid Could Impact A Workers’ Compensation Claim

The attorneys at Fox & Fox Co. L.P.A. are proud to help injured workers seek the benefits they have earned and are entitled to. From experience, we know that the process is often much harder and more complicated than it should be, which is why it is so important to work with an experienced lawyer.

One of the problems you may encounter is how your workers’ compensation claim could be impacted by enrollment in Medicare or Medicaid. Even if you aren’t using either of these programs now, you might run into difficulties later if you have long-term or lifetime coverage for a work-related injury.

It Matters How Your Case Is Settled

Medicare is what’s known as a secondary payer — it is a program that pays costs after a primary payer like workers’ compensation insurance. If you are receiving lifetime care for a work injury, the government wants to have that care covered by WC insurance, even if the rest of your care is covered by Medicare. This arrangement would likely be in effect if you settled your workers’ compensation claim by stipulation and award.

A problem might arise, however, if you opt for a lump-sum settlement, known as compromise and release. By accepting the lump-sum payment, you are agreeing to release the workers’ compensation insurer from future coverage of medical care. In doing so, Medicare may treat you as the primary payer and hold you responsible for future medical bills up to 100 percent of your settlement amount.

The problems caused by compromise and release settlements can be mitigated in a few ways, including the establishment of a workers’ compensation Medicare set-aside agreement. But fixing a problem after the fact is more difficult than preventing it in the first place. That’s why you should work with an experienced workers’ compensation attorney as early in the process as possible.

Contact Us To Discuss Your Case For Free

Fox & Fox Co. L.P.A. has offices in Amelia and Cincinnati, and we serve clients throughout southern Ohio. For a free initial consultation about your workers’ compensation issue, call us at 513-961-6644 or send us an email.